Routine inspection·October 8, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted the facility's annual required visit and inspection. LPA met with Staff #2 (S2) and explained the purpose of the visit. Administrator Ann Solakyan was contacted and arrived shortly after. At approximately 11:15 a.m., with the assistance of staff, LPA conducted a tour of the physical plant. All required postings were observed in the entry area. The smoke alarms were found to be interconnected and battery-operated. A functioning carbon monoxide detector was installed in the kitchen area. A fire extinguisher was located near the kitchen, with a service date of June 18, 2025. Kitchen: All kitchen appliances and fixtures were in working condition. A sufficient supply of both perishable and non-perishable food was observed, properly stored. Knives were secured in a locked drawer. Properly labeled medications were stored in a locked kitchen cabinet. Bedrooms: There were six (6) bedrooms designated for resident use. All bedrooms were private and appropriately furnished with beds, linens, and adequate lighting. Bathrooms: There are two (2) bathrooms designated for resident use. Both were properly stocked and equipped with functional fixtures. The hot water temperature measured at the bathroom sink was 106.9°F. No cleaning supplies or hazardous items were observed in either bathroom at the time of inspection . Common areas: include a living room and a dining area. These areas were appropriately furnished and in good repair. Auditory alarms on all exit doors were functional. The dining table could accommodate the facility’s licensed capacity. LPA observed a small refrigerator in the living area; the administrator stated it was used to store residents’ medications. Upon inspection, expired medications, staff medications, and medications belonging to former residents were found. The administrator immediately removed all expired, staff, and former residents' medications. (Continue on 809C) Surrounding Grounds : Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a swimming pool that is fenced all around it's parameters. The fence was at least five foot high with a gate, that is also five foot high. Gate was observed locked, making it inaccessible to residents to enter. The laundry area is located in the garage, which is inaccessible to residents. The gates at both sides of the home were checked to ensure no locks were installed, and that exits and passageways were clear for emergency evacuation. Resident Files: A review of resident records was conducted to ensure compliance with licensing requirements. It was noted that Resident #1 (R1) had full bedrails and was not receiving hospice services. The administrator immediately removed the bedrails and stated that R1 had fallen while asleep. Additionally, Resident #5’s (R5) file was missing a Medical Assessment (LIC 602A) and Preplacement Appraisal (LIC 603). Resident #6’s (R6) Admission Agreement was incomplete, and the Preplacement Appraisal (LIC 603) was also missing. Staff Files: LPA reviewed staff records to verify that all required forms and training documentation were current and in compliance with licensing regulations. Medications: Medications and medication records were reviewed. It was observed that Resident #3’s (R3) Centrally Stored Medication and Destruction Record (LIC 622) was missing documentation for the month of October. Resident #4’s (R4) medication records were inconsistent. Additionally, Resident #6’s (R6) medication records were incomplete. Temperature: Facility maintains a comfortable temperature of 73 degrees Fahrenheit Exit interview conducted, citations issued, appeal rights given and copy of this report delivered.